Individual
KACIE WEBB PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-L/SLP
Contact information
Practice address
852 UNIVERSITY DR, LAKE CHARLES, LA 70605-6120
(337) 419-0086
(337) 415-0626
Mailing address
3990 N BLUE SAGE RD, LAKE CHARLES, LA 70605-0189
(337) 802-0473
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7374
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2450662
—
LA
Enumeration date
06/24/2015
Last updated
03/21/2018
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